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HealthPayerIntelligence News

Commercial, Public Payer Healthcare Fraud Cases Total $21.6M

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The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims submissions. Public payer programs are frequently targeted...

Assessing Providers for Participation in Value-Based Care Contracts

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Creating strong networks of high-quality healthcare providers can be a major challenge for any payer looking to expand its value-based care contract portfolio. Providers aren’t the only ones accepting risk when entering into pay-for-performance...

Cigna Files with SEC to Begin $67B Express Scripts Acquisition

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Cigna has submitted a filing to the Securities and Exchange Commission (SEC) to complete a $67 billion acquisition of the pharmacy benefit manager (PBM) Express Scripts. The payer filed the merger agreement under a temporary parent company called...

Adding Telehealth, Remote Care Benefits into Health Plan Options

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Payers that include telehealth and remote care benefits in their health plan options could position themselves as leaders in health plan value, convenience, and innovation. Health plans are challenged to improve customer service and member satisfaction...

CMS Highlights Drug Price Transparency Data Dashboards

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CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore data...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

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Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from Hogan’s...

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

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Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including some...

More Competition May Benefit Medicare Advantage Bidding Process

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The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings Institute report. Brookings analysts believe...

Managing Payer Challenges in the ACA Risk Adjustment Program

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The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces.   Under the ACA, payers can only adjust...

Commercial Health Plan Customer Satisfaction Remains Steady

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Commercial health plan customer satisfaction rates remained stable from 2017 to 2018, but payers still have a number of opportunities to improve their customer service and beneficiary education, according to a new JD Power consumer survey. The...

CMS Increases Payments for Durable Medical Equipment

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CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices. The rule will raise DME payments to Medicare providers from June...

Improving Health Plan Customer Service Through Technology

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High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions. Customer service plays several important roles for health plans.  In addition to the stand-alone goal of leaving...

How Payers Can Address Food Insecurity among Plan Beneficiaries

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Payers are constantly challenged to provide their health plan beneficiaries the best possible healthcare experiences, but may have trouble doing that if members experience food insecurity. Food security is just one lifestyle need that plays into...

CMS Approves Medicaid Work Requirements in New Hampshire

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CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility.  The approval makes New Hampshire the fourth state to integrate...

Using Social Determinants of Health for Risk Stratification

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Engaging in meaningful risk stratification of beneficiaries requires accurate data that can highlight opportunities to reduce costs and improve outcomes for plan members. In order for payers to develop accurate and detailed risk stratification...

Verma: Patient Care, Payment Design Need Value-Based Reforms

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Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the American Hospital Association (AHA). During the...

86% of Employers Use Financial Incentives in Wellness Programs

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Eighty-six percent of employers offer financial incentives in their wellness programs, according to a new survey from the National Business Group on Health (NBGH) and Fidelity Investments.  This represents an 11 percent increase since 2017,...

Former CMS Employee Found Guilty in Insider Trading Scheme

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A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty verdict in the Southern District of New York...

Harvard Pilgrim, Partners HealthCare Discuss Possible Merger

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Harvard Pilgrim and Partners HealthCare are engaging in discussion of a possible merger.  A deal would combine Massachusetts’s largest payer organization with the state’s largest provider group and may create a dominant healthcare...

Supplemental Insurance is a Value-Add Opportunity for Employers

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Employers may have a prime opportunity to add value to their health plan options by offering supplemental insurance, according to a recent AHIP survey. The survey found that 95 percent of employees are satisfied with supplemental plan benefits...

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